Psychological Factors Affecting

Medical Conditions

Stress & Medical Illness

Stressful life events are correlated with
increased risk of becoming medically ill.
Stressors can be perceived positively or
negatively, as mediated by cognitive
''coping'' mechanisms.
Maladaptive ways of coping, such as
smoking, and substance abuse, may alter
susceptibility to illness.

Stress & Medical Illness

A strong network of social support seems
to buffer against effects of stress.
The central nervous, endocrine, and
immune systems are interconnected.
Response to physical and psychological
illness depends both on genetic and
acquired factors.

Diagnostic and Statistical Manual of

Mental Disorders (DSM-IV)
Uses psychological factors affecting medical
condition instead of psychosomatic medicine
one or more psychological or behavioral
problems that adversely and significantly affect
the course or outcome of a general medical
condition, or that significantly increase a
persons risk of an adverse outcome

A. A general medical condition is present

B. Psychological factors adversely affect the general medical condition in one of the
following ways:
1. The factors have influenced the course of the general medical condition as shown by close temporal
association between psychological factors and development or exacerbation of or delayed recovery from
GMC
2. Factors interfere with the treatment of the general medical condition.
3. The factors constitute additional health risks for the individual
4. Stress related physiological responses precipitate or exacerbate symptoms of the general medical
condition. Ex. Major depressive disorder delaying recovery from myocardial infarction; depressive
symptoms delaying recovery from surgery

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NEUROTRANSMITTERS
Stressors activate the noradrenergic system
1. ( in the locus ceruleus ) and cause release of
catecholamines from the autonomic nervous system.
Stressors also activate the serotonergic systems
( increased turnover of serotonin )
2. Glucocorticoids may increase serotonin 5Ht2 mediated
actions contributing to intensification of of receptors
implicated in pathophysiology of major depressive
disorder

ENDOCRINE RESPONSE TO STRESS

In response to stress - Corticotropin -releasing
factor (CRF ) is secreted from the hypothalamus
into the hypophysial-pituitary portal system.
CRF ---> release of glucocorticoids promoting
energy, increase cardiovascular activity,
inhibiting functions such as growth,
reproduction, and immunity

STEESSFUL LIFE EVENT

PERCEPTION
COGNITIVE COPING AND DEFENSE MECHANISMS
GENETIC AND ACQUIRED VULNERABILITY
TO PHYSIOLOGICAL AND PSYCHOLOGICAL
ILLNESS
SOCIAL SUPPORT

PSYCHOPHYSIOLOGIC CHANEGES
ACUTE ILLNESS OR DECOMPENSATOIN
OF CHORNIC ILLNESS

STRESSOR TO FAMILY. VOCATIONAL

ECONOMIC LIFE, SELF ESTEEM
(i.e. illness is itself a stress)

THE HISTORICAL DEVELOPMENT OF THE

MIND-BODY RELATIONSHIP
current concepts are products of a long
evolutionary process.
Followed the socio-cultural, scientific,
and philosophical trends of each
historical period.
Our early ancestors:
Same diseases we know of today
without aid of todays scientific method or
knowledge of anatomy, physiology, and
behavior.

THE HISTORICAL DEVELOPMENT OF THE

MIND-BODY RELATIONSHIP
Theological explanations were frequently
invoked, such as:
Possession, evil eye, witchcraft
Rituals were used to rid the body of evil
influences.
The powerful attraction of these early
beliefs as explanatory models is apparent
in their continued appeal in our era.

THE HISTORICAL DEVELOPMENT OF THE

MIND-BODY RELATIONSHIP
Hippocrates believed that many diseases
and mental states were caused by
emotions
Mind-body physiology is based on
combinations of:
Four basic humors (yellow bile, black bile,
phlegm, and blood)
With the four basic elements (air, earth, fire
and water).
Various combinations produced different
diseases and mental states.

New Thinking
chronic suppression of emotional tension
leads to discharge in autonomic nervous
system pathways.
Causes structural change in specific
tissues and organs.
The so-called organic neuroses (essential
hypertension, bronchial asthma,
ulcerative colitis, peptic ulcer,
rheumatoid arthritis

Contribution
Type A behavior pattern-characterized by
a sense of urgency, striving for
achievement, and hostility-is a risk factor
for coronary artery disease.
Researchable
Recent critiques found that not all type-A
personality characteristics are equally
associated with this increased risk.

Life Events Scale (Holmes & Rahe)

Death of a spouse

100

Divorce
Marital separation
Jail term
Death of a close family member
Personal injury or illness
Marriage

73
65
63
63
53
50

Fired at work

47

Marital reconciliation

45

Retirement

45

Death of a spouse
Change in health of family
member
Pregnancy
Sex difficulties
Gain of new family member
Business readjustment
Change in financial state
Death of a close friend
Change in number of arguments
with spouse
Foreclosure of mortgage or loan
Change in responsibilities at
work
Son or daughter leaving home
Trouble with in-laws
Outstanding personal
achievement
Spouse began or stopped work
Begin or end school
Change in living conditions

100
44
40
39
39
39
38
37
36
35
30
29
29
29
28
26
26

Death of a spouse
Revision of personal habits
Trouble with boss
Change in work hours or
conditions
Change in residence
Change in schools
Change in recreation
Change in church activities
Change in social activities
Change in sleeping habits
Change in number of family
get-togethers
Change in eating habits
Vacation
Christmas
Minor violations of the law

100
25
24
23
20
20
20
19
18
16
15
15
13
12
11